CEN Exam 1

CEN Exam 1 Which dysrhythmia would be identified on an ECG/EKG six-second strip by a heart rate of 76 and a PR interval of 0.24? tachycardia -degree atrioventricular block bradycardia ional escape rhythm - Answer-B: First-degree atrioventricular block is diagnosed partially by an EKG showing a PR interval of greater than 0.20 seconds. Which blood test may indicate infection or inflammation and would need to be used as part of the clinical picture with diagnosing and treating abdominal pain? blood cell (WBC) count of 5.0 ocrit (HCT) of 45 c.WBC count of 28.0 sugar (BS) of 74 - Answer-C: An elevated WBC count would be indicative of infection or inflammation. The WBC count of 5.0 is normal. The HCT and BS levels listed would also be considered within normal limits. A 30-year-old man comes to the emergency department with the acute onset of left flank pain radiating to the groin. Microscopic hematuria is present on urinalysis. What is the most likely diagnosis? ral calcium oxalate calculus ral cystine calculus cular torsion tis - Answer-A: Ureteral calculi are a quite common cause of acute emergency evaluation, usually causing flank pain with radiation to the back and/or groin. About 75% of these are calcium oxalate or phosphate; less common are struvite, uric acid, or cystine calculi. While KUB or ultrasound may show the stone, helical CT is now the preferred diagnostic method. Additional workup includes CBC, chemistry panel, urinalysis, and straining of urine to catch a passed stone for chemical analysis. Nursing attention should be directed to intravenous hydration with input and output recording and narcotic or narcotic plus NSAID (e.g., ketorolac) administration for pain. Some patients may be discharged with analgesics and instructions for hydration and calculus capture. Testicular torsion is most common in adolescents and usually presents with testicular and groin pain with abdominal radiation; increasing pain by lifting the scrotum to the level of the pubic symphysis causes exacerbation of the pain (Prehn sign). Cystitis may be infectious or drug-induced, but cystitis usually causes dysuria and pyuria and shows positive urine cultures. Which of the following is NOT appropriate for screening for domestic violence by the emergency department nurse? g if the person has been hit, kicked, or otherwise hurt by someone in the past year; if so, by whom g, "Do you feel safe in your present relationship?" asking about intimate person violence if the patient is in the emergency department for a medical ailment, not trauma g if there is a partner from a previous relationship that makes the individual feel unsafe - Answer-C: Domestic violence, nearly always perpetrated against women, is a major problem confronted by the emergency nurse. Screening for possible cases should include answers A, B and D. Interestingly, victims of intimate partner violence often present with a medical ailment, not trauma. These include back, abdominal, or pelvic pain, headaches, urinary infections, sexually transmitted disease, or symptoms consistent with posttraumatic stress disorder (PTSD). Sometimes evidence of old trauma such as healing fractures or cosmetically concealed bruises may point toward the presence of domestic violence. Many victims will deny it but sometimes compassionate questioning in a private setting will elicit a positive response. The nurse may then offer advice, refer to a social agency or shelter, or ask for a consultation by the hospital social worker. A patient is intubated and on mechanical ventilation. The ventilator alarm rings and the airway pressure is found to be elevated. Possible causes include the following EXCEPT: racheal tube obstruction with sputum othorax hospasm leak - Answer-D: Mechanical ventilation requires diligent observation of the patient and ventilator by the emergency nurse. Modern ventilators usually come with alarms that indicate high or low airway pressure. High pressure may be caused by endotracheal tube obstruction with sputum or kinks or inadvertent endobronchial displacement. The airway should be suctioned and tube placement checked. A chest xray is frequently helpful in determining the cause. Lung collapse, worsening of the underlying disease, and bronchospasm are also causes of elevated pressure. Leaks around the endotracheal tube cuffs will cause low airway pressure. Auto-positive endexpiratory pressure (auto-PEEP) is caused by premature inspiratory delivery before full expiration (as in asthma or COPD patients) and may lead to increased pressure and lung damage. A 2-year-old is brought to the emergency department with mild fever, persistent restlessness, crying, and pulling his left ear. He has had a cold for about a week. Examination of the ear reveals a distorted light reflex and slight bulging of the tympanic membrane. What is the proper diagnosis and treatment? s externa and antibiotics s media and antibiotics s media and myringotomy labyrinthitis and antivertigo drug - Answer-B: Ear infections may cause severe and persistent pain, especially in children in the 6-month to 3-year age group and are a frequent cause of emergency department visits. Loss or distortion of the light reflex and bulging of the tympanic membrane are cardinal signs of otitis media, usually caused by bacteria such as Streptococcus Influenza or Haemophilus Influenza. Sinusitis and purulent rhinitis may accompany the otitis. Antibiotics to cover these organisms, topical warmed otic analgesics, and antipyretics are the usual treatment modalities. Otitis externa or swimmer's ear also causes otalgia and frequently follows swimming in contaminated water or a foreign body in the ear. Keeping the ear dry and using otic analgesics and antibiotics are indicated. Ear plugs while swimming or ear drying agents after swimming or showering are the usual preventive measures. Myringotomy is a surgical procedure to keep the middle ear draining in chronic otitis media and hopefully prevent such complications as mastoiditis, meningitis, ruptured tympanic membrane, or permanent hearing loss. Labyrinthitis is an infection of the inner ear and usually causes severe vertigo, most commonly in adults. A 75-year-old man has a history of several episodes of transient right-sided arm and hand weakness lasting an hour or two but with full recovery. He is diabetic and hypertensive and is taking medication for both conditions. This time the episode does not resolve and he is taken to the emergency department some 2 hours after the onset of symptoms. He is awake and able to answer questions and give a medical history. His chest is clear and no bruits are heard over the carotids. There is drift of the right arm on examination and his speech is slightly garbled. His blood pressure is 160/95 mm Hg and his pulse is irregular at 80 beats per minute. A CT of the brain reveals a small leftsided occlusion in a branch of the middle cerebral arterial circulation without hemorrhage. What should be the next step in his management? Continues...